Battle Over Abortion Clinic Restrictions Heats Up

The nation's fight over abortion continues unabated, but the battleground has shifted -- instead of seeking to limit who can obtain abortions, the latest legal attacks on abortion now focus on who can perform them.

In particular, abortion clinic design and hospital admitting privileges for the physicians who work at the clinics have come to the forefront in state legislation pushed by anti-abortion forces.

In the most recent federal court skirmishes over clinic regulation, a federal judge in Texas ruled last week that a requirement to make abortion clinics comply with regulations for ambulatory surgery centers would place an undue burden on women seeking abortions, while a judge in Louisiana ruled Sunday that the state could require abortion providers to have admitting privileges at local hospitals, but temporarily blocked the law from going into effect to give the providers time to comply.

According to the Guttmacher Institute, a pro-abortion rights organization that tracks such laws, 23 states have laws requiring that the clinics meet the same building requirements as ambulatory surgical centers, such as:

Specific sizes for procedure rooms (12 states)

Specific corridor widths (12 states)

A requirement that the clinic be located within a set distance from a hospital (10 states)

In addition, 13 states require physicians to have a relationship with a local hospital, such as:

Admitting privileges (four states)

Admitting privileges or an alternative arrangement such as an agreement with another physician who has admitting privileges (nine states)

"It's a rational way to protect women's health because part of the concern with abortion is that unlike, say, a [dilatation and curettage], when we do surgery on a patient in the hospital, or in a surgicenter, we have review committees that look at quality of care; if there is a complication we present it to a Morbidity and Mortality Committee -- there's accountability," she told MedPage Today. "But the problem with not having anyone looking at the facilities, or looking at the number of complications, is that it allows for degradation in quality."

"Any time you do a surgery there's a potential for an emergency," she added.

Steve Aden, senior counsel at the Alliance Defending Freedom, a religious freedom advocacy group that opposes abortion, said that while some states have imposed outpatient surgery center-type regulations on the clinics for years, the issue of "chemical abortions" using drugs such as RU-486 (mifepristone) adds a new wrinkle.

"The argument from the abortion provider's point of view is that this can be done in a safe manner, but the state is saying with its experts that chemical abortions are more risky for the mother; there are more negative outcomes for the mother than surgical abortion and that's pretty well established," he said in an interview.

As a result, he continued, surgery center regulations are needed with chemical abortions, "but you are getting pushback from abortion providers ... because I think it cuts into their bottom line too much."

Lawrence said ACOG opposes clinic restrictions such as requiring abortion providers to have hospital privileges. Such legislation "only serves one purpose -- to limit a woman's access to care when she needs it."

Although those who support clinic restrictions say they are in the patients' best interest, "in fact, they're actually quite the opposite," Lawrence continued, noting that in the case of the admitting privilege laws, "other outpatient procedures that pose much higher levels of risk -- such as colonoscopy, which has a mortality rate 40 times that of abortion -- are not subject to similar restrictions."

"In fact, these admitting privilege laws can only hurt women; they do that by delaying or even preventing an abortion when a woman needs it," he said. "These laws can actually increase risk to our patients, making abortions less safe."

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